Provider Demographics
NPI:1568674927
Name:ACEVEDO, ALBERTO L (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:L
Last Name:ACEVEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93216-0190
Mailing Address - Country:US
Mailing Address - Phone:661-721-3530
Mailing Address - Fax:661-721-3533
Practice Address - Street 1:1205 GARCES HWY STE 102
Practice Address - Street 2:MEDICAL ARTS BUILDING
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-3657
Practice Address - Country:US
Practice Address - Phone:661-721-3530
Practice Address - Fax:661-721-3533
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC418340207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C418340Medicaid
CA00C418340Medicaid
00C418340Medicare ID - Type UnspecifiedMEDICARE NUMBER